How to Know if You Have High Cortisol Levels, According to Experts

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Reviewed by Dietitian Jessica Ball, M.S., RDCortisol helps regulate stress, sleep and metabolism—but chronic elevation can harm long-term health.
Signs of high cortisol include poor sleep, visceral fat gain and feeling mentally alert but physically tired.
Managing stress, sleep, blood sugar and gut health can help reduce cortisol and chronic inflammation.If you've spent any time on social media lately, you've probably seen cortisol blamed for everything from visceral fat to burnout and sleepless nights. While it's true that this stress hormone plays a role in how you feel, cortisol is essential for many everyday functions. 'It helps regulate your body's stress response, blood sugar, metabolism, inflammation and even your sleep-wake cycle,' says Erica Armstrong, M.D., IFMCP.
The key is to keep cortisol in a healthy range, which healthy adrenal glands manage all on their own. If cortisol levels become too high for too long, you may start to notice some unpleasant side effects, and your health could be at risk. To untangle fact from fiction when it comes to cortisol, we spoke with physicians to understand what this stress hormone does, how to spot when it might be out of balance and steps you can take to manage inflammation and feel your best.
'Cortisol is a hormone produced by your adrenal glands that plays an essential role in your health,' says Armstrong. This hormone naturally follows a 24-hour cycle, peaking 30 minutes after waking up, and declining during the day, with the lowest levels occurring during the early phases of sleep.
As a stress hormone, cortisol is regulated by the hypothalamic–pituitary–adrenal axis (HPA axis) and surges during times of high stress. A burst of cortisol leads to high amounts of sugar released into the bloodstream for extra energy, vasoconstriction and increased heart rate to get your body ready for the 'fight or flight' response. This response is useful in a situation when you need to move or act quickly, but can create problems when it occurs too frequently, and without the follow-up of physical action.
Most cells in the body have cortisol receptors, meaning that this stress hormone impacts everything from your heart to your brain, metabolism, immune system and more. Chronically high cortisol levels are a biomarker for a number of diseases, including heart disease, stroke, type 2 diabetes and other metabolic and inflammatory conditions. Some of the most common causes for elevated cortisol include chronic stress, insulin resistance, autoimmune diseases and Cushing's syndrome, explains Armstrong.
The only way to know if you have high cortisol levels is to see a medical professional. 'We always combine symptoms with lab testing (like a 4-point saliva cortisol test) and a full clinical picture before concluding whether cortisol is truly out of balance,' says Armstrong.
That said, these are some of the most common signs of high cortisol:
If you have trouble falling asleep at night or tend to wake up in the middle of the night and can't fall back asleep, it could have something to do with your stress hormones. 'Cortisol should be low at night, but if it's spiking due to stress or blood sugar dips, it can wake you up in the middle of the night,' says Armstrong.
One study of healthy individuals found that higher pre-sleep cortisol levels were associated with shorter and poorer sleep quality than lower pre-sleep cortisol levels. A similar connection was also found among people with type 2 diabetes. Left unaddressed, poor sleep quality and short duration can lead to a number of health concerns, including an increased risk of heart disease and all-cause mortality.
If you find yourself holding on to extra weight around your midsection, despite no changes in your diet or exercise routines, it could be a sign of high cortisol levels. In one study of middle-aged and older adults, those with higher levels of hair cortisol were more likely to have a higher body weight and waist circumference than those with lower levels. 'Cortisol promotes fat storage, especially around the midsection, as a survival mechanism,' says Armstrong. While the chances of elevated cortisol are higher in those with abdominal obesity, many people who may fall on the obesity scale do not have elevated cortisol.
As a stress hormone, cortisol helps your brain stay ready for impending danger, which can feel downright exhausting when you're stuck in that state for too long. 'Elevated cortisol can make you feel mentally alert even when you're physically exhausted,' says Armstrong.
However, even if you're feeling mentally wired, chances are your brain isn't operating at its best. High levels of cortisol, maintained over long periods, are associated with reduced cognitive function and impaired sleep, which can further impair mental functions such as memory and attention.
Working to lower elevated cortisol levels can help reduce chronic inflammation and the risk of inflammatory diseases. Here are other expert-approved ways to manage inflammation:
Follow an anti-inflammatory diet: An anti-inflammatory diet rich in omega-3 fatty acids, plenty of colorful fruits and vegetables and fiber-rich legumes can help support your body's natural ability to regulate inflammation and stress.
Work to balance your blood sugar levels: 'Stabilizing blood sugar through regular meals with protein, fat and fiber can calm both inflammation and cortisol spikes,' says Armstrong.
Focus on stress management: Managing your mental, emotional and physical stress with adequate rest and prioritizing mental health and self-care activities can help reduce stress and inflammation. Research supports the use of mindfulness, meditation and relaxation interventions as effective ways to manage and lower cortisol levels.
Prioritize sleep: 'Even one night of poor sleep can elevate inflammatory markers,' says Armstrong. As inconsistent sleep is highly associated with inflammation, creating and sticking to a consistent sleep schedule and routine should be a top priority in your inflammation management plan.
Take care of your gut health: The gut microbiome plays a crucial role in regulating your immune system and controlling inflammation. 'Addressing microbiome imbalances, food sensitivities, or underlying infections through personalized protocols can dramatically reduce systemic inflammation,' says Armstrong.
When operating correctly, your body has systems in place to regulate cortisol production and release for an appropriate stress response. So while most people do not have to worry about elevated cortisol, chronically high levels can cause unwanted side effects and increase the risk of inflammatory and metabolic health conditions. Difficulty sleeping, abdominal weight gain and feeling mentally wired but physically tired can indicate elevated cortisol levels; however, these symptoms could also be caused by a variety of other health conditions or imbalances. The best way to know for sure is to speak with a healthcare provider.
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